Research ArticleOriginal Research

Deployment of a Digital Advance Care Planning Platform at an Accountable Care Organization

R. Lynae Roberts, Desh P. Mohan, Katelin D. Cherry, Samantha Sanky, Taylor R. Huffman, Christina Lukasko, Anthony Comito, Dara Hashemi, Zachary K. Menn, Tatiana Y. Fofanova and Julia D. Andrieni
The Journal of the American Board of Family Medicine November 2023, 36 (6) 966-975; DOI: https://doi.org/10.3122/jabfm.2023.230133R2

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Patient engagement and completion workflow.

  • Figure 2.
    Figure 2.

    Percent of participants indicating their opinion on the spectrum of answers to the question “What does quality of life mean to you?” (n = 105 respondents).

  • Figure 3.
    Figure 3.

    Number of participants’ indicating which circumstances would severely impact their quality of life in a way that they would consider unacceptable (n = 114 respondents, multi-select items).

Tables

  • Table 1.

    Participant Demographic Characteristics (n = 203)

    CharacteristicParticipants
    Age, M (SD)75.5 (11.3)
    Gender, n (%)
     Women127 (62.6%)
     Men76 (37.4%)
    Ethnicity, n (%)
     Hispanic or Latino27 (13.3%)
     Not Hispanic or Latino175 (86.2%)
     Unknown1 (0.5%)
    Race, n (%)
     Black/African American60 (29.6%)
     White/Caucasian126 (62.1%)
     Asian13 (6.4%)
     Native Hawaiian/Pacific Islander1 (0.5%)
     American Indian/Alaskan Native1 (0.5%)
     Other/unavailable2 (1.0%)
    Religion, n (%)
     Christian, Catholic42 (20.7%)
     Christian, Protestant82 (40.4%)
     Christian, not specified further28 (13.8%)
     No preference25 (12.3%)
     Hindu2 (1.0%)
     Jewish4 (2.0%)
     Other20 (9.9%)
    Marital Status, n (%)
     Married/Life Partner111 (54.7%)
     Divorced/Separated21 (10.3%)
     Widowed47 (23.2%)
     Single24 (11.8%)
    Living Situation, n (% of 118)
     With other(s)92 (78.0%)
     Alone/Independent living20 (16.9%)
     Assisted living/Nursing home3 (2.5%)
     Other3 (2.5%)
    Area Deprivation Index (ADI), n (%)
     Lowest SES (ADI 81 to 100)27 (13.3%)
     Lower-mid SES (ADI 61 to 80)45 (22.2%)
     Mid SES (ADI 41 to 60)59 (29.1%)
     Upper-mid SES (ADI 21 to 40)40 (19.7%)
     Highest SES (ADI 1 to 20)32 (15.8%)
  • Table 2.

    Participants’ Koda ACP Platform Choices Regarding Common Life Support Treatments Under Two Possible Circumstances: Current State of Health and Unacceptable Quality of Life

    Life Support Treatment PreferencesParticipants
    n (%)    		Racea Difference
    (χ2) p-value    		ADI Difference
    χ2p-value
    CPR Preference current health, n = 1110.0420.264
     Always Want24 (21.6%)
     Only If Recommended53 (47.7%)
     None At All19 (17.1%)
     Not Sure15 (13.5%)
    CPR Preference if unacceptable QoL, n = 1110.0030.509
     Always Want17 (15.3%)
     None At All68 (61.3%)
     Not Sure26 (23.4%)
    Mechanical Ventilation current health, n = 1100.6540.293
     Any Length of Time6 (5.5%)
     Trial76 (69.1%)
     None At All22 (20.0%)
     Not Sure6 (5.5%)
    Mechanical Ventilation if unacceptable QoL, n = 1100.1900.594
     Any Length of Time6 (5.5%)
     Trial39 (35.5%)
     None At All56 (50.9%)
     Not Sure9 (8.2%)
    Artificial Feeding current health, n = 1100.7210.327
     Always Want5 (4.5%)
     Only If Recommended66 (60%)
     None At All36 (32.7%)
     Not Sure3 (2.7%)
    Artificial Feeding if unacceptable QoL, n = 1100.1070.207
     Always Want9 (8.2%)
     None At All78 (70.9%)
     Not Sure23 (20.9%)
    Dialysis current health, n = 1090.2510.806
     Any Length of Time13 (11.9%)
     Only If Recommended64 (58.7%)
     None At All25 (22.9%)
     Not Sure7 (6.4%)
    Dialysis if unacceptable QoL, n = 1100.0010.553
     Any Length of Time23 (20.9%)
     None At All61 (55.5%)
     Not Sure26 (23.6%)

    • aRace differences assessed only between White/Caucasian and Black/African-American due to final sample rates on this variable.

    • Abbreviation: ADI, Area Deprivation Index, our proxy measure for SES.

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